Patient Question & Answer

What are the risks of going too big when getting breast implants?
The risk of going too big with breast implants include an unnatural look, unnatural shape, symmastia in which the implants are touching in the middle, bottoming out, and stretching of the tissues.

I have symmastia. My surgeon has said that he will switch to smaller implants and that this will solve the problem. Does this sound right?
Symmastia may not be fixed with just a smaller implant because the pocket is still open. We like to use Strattice or acellular dermal matrix to help control the pockets when we’re fixing symmastia.

I would love to have larger breasts but I really dislike that look of the breast implants where the breasts look like two round balls on the chest. Is the shape more natural if you use fat instead of implants?
Fat might provide a more natural look but there also techniques with implants that can do this as well. It depends on the patient. The sub-muscular placement doesn’t give the appearance of two round balls. Also, choosing the right size for the patient’s body is important for obtaining a natural breast result.

What is Strattice? What are the instances when it’s used in breast surgery?
Strattice is porcine acellular dermis. This is skin from a pig that’s been treated to have no cells in it. We use it quite frequently for revision breast surgery and in primary mastopexy augmentation when the tissues are very thin. In our practice, it has phenomenal results in treating capsular contracture.

I have symmastia. What causes this? Is it something the surgeon did wrong?
Symmastia is when the breast implants communicate in the central portion. This can be due to over dissection of the tissues. It is corrected with Strattice and correcting the pockets so they are not so close together.

How is breast reduction performed? Does the surgery lift the breasts at all?
A breast reduction is really a breast reduction with a lift combined. We excise skin and reshape the breast to lift the breast at the same time as the reduction.

I’m really unhappy with my breasts since having my kids. They’ve lost their fullness and are very saggy. What sort of results could I expect from a breast lift alone without implants?
Patients who are unhappy with their breasts after children who have sagginess can often benefit from a breast lift. Patients need to come in for a consultation so we can evaluate what the breasts looks like. A breast lift will lift the breast to a higher position and get rid of some of the sagginess but it won’t provide a tremendous amount of added fullness. For more fullness, implants are best in combination with the breast lift.

My girlfriend has capsular contracture and her surgeon recommended something called closed capsulotomy. Can you explain what this is and whether or not it’s the right approach?
A closed capsulotomy is when you squeeze a breast to help pop a capsule contracture. This is not considered the best procedure to use at present. We treat most patients with capsular contracture with a surgical approach of complete capsulectomy, implant exchange, and usually Strattice placement. However, with the new ultrasound system from Aspen Laboratories, we can sometimes treat this non-surgically. Patients need to come in for a consult and we need to examine the patient.

Are results of natural breast augmentation using your own fat permanent?
The result of natural breast augmentation with fat is a permanent procedure. As patients lose or gain weight, there may be some change in the shape and size of the breast.

Is it true that most breast augmentation surgeries today involve the new silicone implants? What are some reasons to go with saline instead?
Most of the breast augmentation procedures done in our office are with silicone. The silicone implants feel more like a natural breast with less rippling. Some women like to go with saline implants because they still have some unreasonable fear of silicone implants. At this point, the silicone implants are considered very safe. Other reasons for using saline implants are for women under age 22 because the FDA has mandated that you have to be 22 and over to get silicone implants.

I believe I have gynecomastia. My chest is just far too female-like for a guy. Can I have surgery to fix this or do I first need to see a doctor to treat the gynecomastia?
We see many patients who have gynecomastia in our practice. In our center, it is a combination of a surgical fix and nonsurgical fix. We do hormonal tests for everybody with gynecomastia to check their estrogen levels to make sure that these are within normal limits. Otherwise, we believe that gynecomastia will come back after treatment if the estrogen levels are too high. Surgery usually involves Vaser liposuction to sculpt the chest. However, sometimes excisional procedures are needed.

When should I be able to go back to work after getting breast reduction?
Drains are used for different breast augmentation surgeries as to the preference of the surgeon. In our practice, we do not use drains for primary augmentation and for minor corrections. However, for significant breast corrections including capsulectomies and position changes under the muscle, we do use a drain.

When should I be able to go back to work after getting breast reduction?
Patients should be able to go back to work after breast reduction after a few days. Breast reduction is usually not as painful or debilitating a procedure as breast augmentation which may require a longer time out of surgery especially, when the implant is placed under the muscle.

I’m 26 and I’m interested in some type of breast procedure. I’d like my breasts to be a little larger and also fix some minor droopiness. Would breast implants alone help to lift the sagging or do I need a breast lift too?
Now, it is difficult to determine whether an implant will create enough lift or if that patient will need a breast lift without really examining the patient. But in most cases, with a small amount of droopiness, implants will help that droopiness.

I’m doing research into breast lifts. I recently heard somebody called a Benelli lift. Can you explain what this is?
A Benelli lift, or circumareolar mastopexy, is a breast lift with the incision around the areola. This is good for patients who need a small amount of lift and is not the answer for significant sagging to the breast.

I’m interested in breast lipoaugmentation. How is the fat placed in the breasts? Where are the injections made and will there be noticeable needle marks afterward?
In breast lipoaugmentation, fat is harvested from other areas of the body and then re-injected into the breast. The holes that are used to place the fat are very small. There are no needle marks.

I recently saw something on the TV where high school girls were getting breast implants. I thought you had to be 18. How does this happen?
The FDA mandates that patients be 18 prior to breast augmentation; however, there may be some scenarios where there is severe asymmetry or developmental issues where younger women might be having breast augmentation surgery but these are few and far between.

Is a boob lift the same as wearing a push-up bra? If so, what are the reasons to opt for the surgery?
A breast lift is a surgery in which the breast tissue is lifted up with or without an implant to create higher, more youthful appearing breasts. A push-up bra may be able to give you this type of appearance; however, many patients prefer not to wear a bra and prefer to be able to wear an evening dress, a tank top, or a bathing suit without pushup and look more youthful.

I’m in my 30s and had stents placed in my heart several years ago. Can I still be a candidate for breast augmentation?
For breast surgery, patients with cardiac issues need clearance from their cardiologist. We want to make sure that the patient is healthy prior to undergoing any elective surgery. The issue with stents is that some patients are on blood thinners and, again, this may need to be stopped and this requires consultation and discussion with your cardiologist.

Once the breast surgery recovery is complete, does the presence of implants limit any activities in any way?
The only thing that we ask our patients with implants placed under the muscle is that they avoid strenuous chest exercises for approximately three months after their surgery.

Is there anything that can be done to prevent capsular contracture?
Capsular contracture is a problem most likely due to a biofilm of different bacteria. It’s a very difficult problem. We do specific things to prevent capsular contracture, such as antibiotic irrigation, intravenous antibiotics for the patient, and a no-touch technique we use with the Keller funnel. Postoperatively, we have the patient massage and also take antibiotics. These are simple things that can be done to hopefully prevent capsular contracture.

What is the risk of overfilling implants?
This question pertains only to saline implants which are typically overfilled. For example, a 350cc saline implant is usually filled to almost 400cc’s as per the manufacturer’s recommendations. If you go much larger, that could change the shape. If the implants are underfilled, they can lead to breast implant rippling.

What are the pros and cons of smooth implants compared to textured implants?
In the United States, most surgeons use smooth implants and we are used to putting smooth implants under the muscle. Outside of the United States, textured implants are very popular. There are pros and cons of both. Some people feel that textured implants cause breast capsular contracture, however in most studies this has not been the case. We still prefer smooth implants as they ripple less.

How does the shape of the ribs affect breast augmentation?
The shape of the ribs does affect breast implants because they can push the implant out and cause changes in shape, especially if one side has more prominent ribs than the other. Many times patients with extremely prominent ribs will need different size implants if the ribs sizes are different.

I’ve had complications related to an infection of my right breast after breast implants. It’s been a long time dealing with it. Now, I’m looking to replace the implant. My doctor wants to replace the new implant over the muscle though the implants were originally placed under the muscle and this will mean that the left breast will remain under the muscle. Will my breasts appear different with one implant over and one implant under?
In my observation, this is not a great idea. I usually prefer to place the implants under the muscle, especially if they were originally placed under the muscle. I typically do not have one breast implant over and one breast implant under the muscle. This can lead to a different shape down the road.

I have developed a seroma after my breast augmentation. My doctor says it will be absorbed in time and I’m wondering how long this will take and if there’s anything I can do to speed the recovery.
Seromas that occur right after breast augmentation will resolve. Sometimes we do a small procedure with something called a SeromaCath to drain this without injuring the implant. Seromas that happen late after breast augmentation need to be evaluated.

Once the breast surgery recovery is complete, does the presence of implants limit any activities in any way?
The only thing that we ask our patients with implants placed under the muscle is that they avoid strenuous chest exercises for approximately three months after their surgery.

I have extremely large buttocks and small breasts. Is it possible to transfer fat from the buttocks to the breast? I think fat grafting will be healthier for breast augmentation than an implant.
It’s not a question if fat grafting would be as healthy as breast implants, but many patients prefer not to have an implant placed. Fat can be removed from the buttocks and placed in the breasts, however you have to be very careful not to cause buttock droopiness.

I was told I have fibroadenomas. Can you explain what these are? I’ve been considering breast reduction and I’m wondering if I can still undergo surgery.
Fibroadenomas are benign tumors of the breast and need to be evaluated before breast reduction can be performed. Many times during breast reduction we can remove these fibroadenomas.

I know that often breast implants need future operations because they don’t last forever. Is this the case with breast lifts and breast reduction surgery?
Breast lifts and breast reductions may last the lifetime of the patient, although if patients have extremely saggy skin they might need some extra skin taken out as they age or after pregnancies.

Is it true you cannot workout hard if you have implants placed in the submuscular location?
No, that is not true. We place implants in the submuscular position very frequently for women who work out hard.

I had breast augmentation with saline implants about 15 years ago. How do I know when the implants need to be replaced? Lately I’ve been “feeling” my left implant much more and my breast is somewhat sore. Is this a sign that it should be replaced? If so is it better to replace my implants with silicone?
Most frequently we are replacing breast implants with silicone implants these days as the implants of today are far superior to the so called implants of the yester year. At 15 years, the saline implants may be perfectly normal. However, if the patient is starting to feel or having a change of that implant, they need to come for an evaluation.

I’ve heard that certain criteria must be met for breast reduction to be covered by health insurance, such as a certain amount of tissue must be removed. Is this true and what are the criteria?
Insurance for breast reduction varies by carrier. Each individual policy needs to be checked before a blanket statement can be made about what gets covered.

What is a Benelli lift?
A Benelli lift is also called a circumareolar mastopexy where incisions made all the way around the areola to lift the nipple and areola complex or to reduce the size of the aerola.

What can I expect for the consultation of breast augmentation?
During a consultation for breast augmentation, we will go through the risks and benefits of the procedure, talk about the different types of implants and size with either a Vectra 3-D imaging system or with implants placed in a bra. We would also talk about the anesthesia and the whole procedure of breast augmentation surgery.

Do breast implants lead to breast cancer?
There have been numerous studies that show equivocally that breast implants do not lead to breast cancer. In fact, breast implants are used in cancer reconstruction procedures routinely.

My breast reduction was a week and a half ago. My breasts appear uneven. One breast is much higher than the other and seems harder. Is this anything I should be concerned about? Will it correct itself?
For breast reduction formed from a week and a half ago, it’s hard to assess breast asymmetry. One needs to be careful for hematomas that could cause changes in early breast shape and these need to be drained if present.

I feel like my breast reduction 7 years ago was a hack job. I got an infection afterward and the scars are horrible. Is there anything that can be done to fix this?
Patients with poor scarring or after infections after breast surgery can be corrected with further surgery or with laser surgery on some of the scars. Patients need to come for a consultation to see what is the best method of treatment.

I’m interested in a Benelli lift. I’m wondering how much lift can realistically be expected. I am a B cup with sagging and considering implants as well to go a full C cup.
It’s very difficult to describe how much of a breast lift a patient needs without examining the patient. A Benelli lift is very good for small amounts of lift.

Is bleeding still normal two weeks after a breast lift?
Bleeding is not normal two weeks after a breast lift and one must see their doctor.

What are gummy bear breast implants? Is it true that they’re being used outside the US?
Gummy bear breast implants are breast implants made by both Mentor and Allergan company that are more cohesive than typical cohesive gel implants sold in the United States. These are firmer, usually textured and an anatomical teardrop shape and are not yet available in the United States.

How often are drains used after breast augmentation? What are they used for and how long are they typically used?
We use drains after very complicated breast augmentations, usually secondary cases and after capsulectomy and also when I place products such as strattice or alloderm. I do not use drains after a typical breast augmentation. Drains in these complicated cases are removed when the drain is getting to a minimal point, usually after 4 or 5 days and sometimes up to a week.

I’m interested in male breast reduction. Needing to do the surgery is embarrassing enough and I don’t really want noticeable scars as further evidence. How noticeable are the scars and where are they located?
For male breast reduction, most of the time we can accomplish this through small hidden scars and we use laser liposuction in our practice to suction out the fibrous breast tissue. For resistant male breast and in some cases with no scarring a small incision needs to be performed around the areola and these are very non-noticeable.

Is there any proof of breast implants being related to auto immune diseases?
This was extensively studied in the middle of the 1990’s. Currently there is no proof of any relationship between breast implants and auto immune diseases.

Do breast implants cause the areola to become stretched?
The areola may stretch with breast implants depending on the size of the implants and the laxity of the breast, or how tight the breast is to start with.

What is a circumvertical breast lift?
Also known as a vertical breast lift, this is a procedure with an incision around the areola and a vertical incision. This incision can also be used for breast reductions. We use this quite frequently in women with a moderate degree of breast drooping or ptosis.

Will breast reduction decrease the size of the breast but leave them full? I have a very full, firm breast but I’m now worried that surgery will decrease this. What precautions if any may I take to keep the fullness?
The goal during breast reduction is to create more fullness, not less fullness. So a woman with full breasts should continue to have fuller although smaller breasts after breast reduction surgery.

Is there such a thing as a scarless breast reduction?
There are ways to treat larger breast with just liposuction which is virtually a scarless operation. There are other scarless breast reduction procedures just using an areola lift to correct this. I’ve seen some of the best breast reductions performed this way by Dr. Hilton Becker who uses a mesh in the inferior portion or bottom portion of the breast to create a lifting effect with the breast reduction.

I had a breast reduction years ago and I’ve lost a lot of weight. My breasts have further reduced in size which I’m happy about but now they’re very saggy. Can a breast lift help and will it utilize the same incision lines that we used for the breast reduction so that I don’t end up with additional scarring?
It is very common for women who’ve had breast reduction in the past to have another surgery later on in life with more skin that is excised. In fact, the use of breast implants on patients who had breast reductions is also quite common in our practice for women who have lost a lot of weight or have lost a lot of breast size. So, you can either excise more skin and reposition some breast tissue or do the same and add an implant for this particular situation.

Can women with breast implants breast feed?
The answer is most likely yes, although some patients with implants would never be able to breast feed because some women are just unable to do so regardless of the implants, in which case it may or may not be related to the breast surgery.

If you look on the internet, it seems a lot of breast reduction surgeries go wrong and lead to dead tissue or horrible wounds. Why does this happen and how can it be prevented? How safe is breast reduction surgery?
Unfortunately, only the worst cases and problem cases end up on the internet. People don’t really share their wonderful experiences. In fact, breast reduction is the number one surgery in plastic surgery for satisfaction rates. Most heal very well with very satisfied patients. Patients who smoke oftentimes have wound healing problems, so we don’t operate on smokers for breast reduction and make the patients stop at least 30 days with no patch or no nicotine gum prior to their breast reduction surgery.

My breast are about two cup sizes different, is it possible to get a breast reduction for just the larger breast? Would health insurance cover this?
For asymmetric breasts, it is very possible to get a breast reduction on the larger breast and not the smaller breast. Patients need to send photos or come in for a consultation to really determine this. Health insurances vary. They may or may not cover this type of surgery.

I’m debating between a breast lift with implants or implants alone. I’m relatively young and my breasts are only somewhat droopy. I’m not sure that my case warrants the extensive scarring of a breast lift. Can you tell me who the usual candidates are for breast lift with implants versus implants alone?
To determine who is a candidate for a breast lift with implants versus implants alone, you need to really look at the patient and evaluate the amount of droopiness to the breast and the skin quality. Some patients who just want a minimal increase in size will not do well without a full lift, while some of these patients who have a slightly larger implant will fill out the breast more and not really need a lift. Other patients, no matter what implant size you choose, you will need a lift if they’re significantly droopy.

How extensive is the scar after a breast lift? Are there any techniques to minimize scarring?
There are many different techniques for breast lift, including circumareolar mastopexy which is an incision around the areola or vertical mastopexy which is an incision around the areola and then down vertically. The full Wise pattern or a T-type of mastopexy is an incision around the areola, down vertically and across the breast crease. My tendency is to treat the patient individually. Some people just will not do well with a minimal type of breast lift, while other people will do very well with a minimal type of breast lift. Patients need to come in for consultation or send us photos for us to evaluate that. In terms of scar therapy, we use many different types of scar therapy afterwards including taping the wounds for three months and then treating with different lasers and other scar techniques to really minimize scarring so that after some time the scars do go away to almost nothing.

I lost a significant amount of weight and my breasts shrunk quite a bit and left me with some stretch marks. There isn’t any real sag so I don’t think I need a breast lift. I’m considering augmentation but worried that the stretchmarks will look worse. How will breast implants affect the stretch marks?
Breast implants will actually improve many of the stretchmarks on the breast caused from weight loss, but it is individual and some may see no improvement. Our tendency is to treat some of these stretchmarks with the different types of laser therapy which can help minimize some of the stretchmarks on the breast or even on the body.

What has changed with silicone implants that they’re now considered safe?
The answer is the FDA re-approved silicone implants because it’s their finding that the previous studies and media blitz surrounding the older implants were scientifically unfounded and that, in terms of the safety of the implants, they were very sound and very safe. However, the silicone implants we use nowadays are slightly thicker or more cohesive than the implants we used in the past with much less tendency to break. Also, the quality control from the implant companies has gone way up. So there’s much less of a tendency for these implants to break. However if they do break, they are safe.

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